Health cost avoidance system

Abstract

Complications of various diseases have ascertainable direct costs and indirect costs. A method of projecting direct and indirect cost savings which may be realized from targeted interventions for achieving desired clinical outcomes which may result in the avoidance or mitigation of the complication is provided. Further, a comprehensive patient care management program is provided whereby the targeted intervention strategy of the present invention provides a list of behavioral influencers which assist in achieving desired clinical outcomes. From the achievement of the desired clinical outcomes direct and indirect cost savings from the avoidance or mitigation of a complication provides a projected overall cost savings which may be realized for an employer sponsored health plan.

Description

FIELD OF THE INVENTION [0001] The present invention generally relates to the field of cost analysis for employer sponsored health plans, and particularly to a system for projecting direct and indirect health care cost savings which may be realized from specific mitigating interventions taken for a complication of a disease. BACKGROUND OF THE INVENTION [0002] In the field of health care escalating costs are a common concern for both the consumer and provider alike. Numerous health care service / benefit programs, i.e., managed care, group health, and the like, have attempted to stem these rising costs by utilizing cost projection analysis techniques. Traditionally, disease management companies only provide employer sponsored health plans with considerations of hard savings realized when calculating the impact of their disease management programs. Thus, the disease management programs quantify the direct costs associated with a particular medical procedure, disease, and / or course of tre...

AI Technical Summary

Benefits of technology

[0007] It is an object of the present invention to assist in providing a systematic and comprehensive approach to patient and / or disease management. Through use of the present invention, patients may be provided with an individualized care plan which may influence behavior, such behavior influences being directed towards increased health for the patient and cost savings / avoidance for the health care plan provider by proper disease management which accounts for the direct and indirect costs associated with the progression of various diseases. Using a prevalence-based focus on disease-specific behaviors that may have the most significant impact on improving individual health the present invention relates the achievement of desired clinical outcomes / targeted interventions to the avoidance of complications, such complications are based on the progression of a disease over time. By focusing on determining what interventions have the most impact in improving a patient's health, future costs of complications of the disease may be mitigated / avoided. The focused intervention strategy of the present invention is based on a hierarchy of targeted interventions which achieve a desired clinical outcome and have the most impact upon the progression of a disease, particularly the development of complications associated with the disease.

[0010] It is a further object of the present invention to provide the cost savings projection method for various complications associated with the progression of various diseases. By providing and using the indirect costs associated with a complication of a disease, the present invention provides a significant advantage over the prior art. The cost savings projection of the present invention goes beyond the limited return on investment analysis of direct costs typified by current health plan cost projection modeling techniques and gives quantifiable (return on investment) information on direct and indirect costs associated with such things as absenteeism, disability, and presentism. These indirect costs may amount to billions of dollars per year lost to providers and consumers of health plans. With the cost savings projection enabled by the present invention, the employers and / or consumers are provided a more detailed and accurate account of all the possible benefits, related to direct and indirect costs, of various alternative care strategies before having to implement them.

[0012] It is an object of the present invention to present a method of non-claims based calculation of savings which applies cost savings assumptions to the successful achievement of clinical outcomes / targeted interventions. This allows the present invention to provide program benefit information to those employer sponsored health plans which do not have credible population pool size.

Problems solved by technology

The currently employed cost projection techniques may only be providing a return on investment analysis, based on these direct costs.

Unfortunately, the direct cost return on investment analysis provides a limited view of the total costs which may be associated with managing a disease.

Beyond the direct health care costs of managing a disease are the indirect costs, such as the costs associated with absenteeism, presentism, and / or disability.

These indirect costs, which are commonly borne by employers who lose productivity due to absenteeism and / or presentism and the employers who have to pay for workers compensation due to disability, are often not accounted for by the current cost projection techniques.

Unfortunately, current cost projection modeling techniques may fail to identify these types of indirect cost savings in a quantifiable manner and therefore the cost savings projected may fail to provide an accurate account of the benefit of these programs.

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